Society is becoming more exposed to extreme incidents of trauma and disaster, with acts of terrorism, severe crime and natural disasters immediately broadcast via social media, and many news outlets reporting unfolding events in real time.

As a result, mental health professionals are being urged to take the unique circumstances of highly publicised traumatic events into consideration when providing coping strategies to victims.

“Mental health professionals are usually the first point of contact for people looking for support following large scale, major traumatic incidents, and the support that is provided in the first days and weeks can greatly shape a person's recovery,” says psychologist Greg Prescott, an expert in trauma and disaster response.

“With wait times for psychologists varying from days to months, the advice given at initial consultation with other health professional needs to be enough to start recovery.”

Acute reactions to major trauma begin with the fight or flight response, says Mr Prescott.

These reactions are characterised by high levels of adrenaline which can present with symptoms including psychomotor agitation, rapid speech, difficulty concentrating, headaches and nausea.

“In the days following an incident it is common to see some of the acute physiological symptoms decrease and psychological symptoms increase,” he says.

“Common early psychological symptoms include hypervigilance, guilt, generalised fear and anxiety, intrusive thoughts/images, flashbacks, withdrawal, and emotional numbing.

According to Mr Prescott, highly traumatic incidents such as the Bourke Street rampage in Melbourne, and other acts of terror or extreme crime, are unusual for a number of reasons.

“People affected by these type of large scale incidents, whether directly or indirectly, will often have subsequent exposure to the incident via social media, news and media outlets,” says Mr Prescott.

“Especially in the early stages of treatment, it is advised for people to avoid recounting the event or repeatedly ventilating emotional reactions.

“The repeated exposure and the volume of questions that come with social media and access to news and media outlets can result in people becoming more traumatised by an incident.”

Giving victims of these type of incidents strategies to avoid over-exposure to media coverage, along with pre-prepared scripts to deflect questions during the early stages of recovery, can assist in symptom reduction and improved outcomes.

It’s crucial that victims have their mental health considered as early as possible, starting with those on the frontline.

“Paramedics and first responders are typically involved in the very acute phase of a traumatic reaction, and support at this stage should focus on the practical - physical safety, food and hydration.

“However, providing clear directions such as what to do and where to go can help people through the initial stages.
“Once the incident is over, basic psychological first aid can be provided, with recommendations to seek professional help if required.”

Emergency Response staff and General Practitioners are often the next resource sought out by victims of major incidents.

While treatment of physical injuries should take precedence, care can be taken after treatment, or even during treatment for minor injuries, to provide a sense of safety, security, and where possible, a sense of agency.

“Simple things like asking a person if there is someone who can be called, giving them choices over things, can help someone in a helpless position feel some small amount of control, which is predictive of better long-term psychological outcomes.

“Where possible giving clear directions for referral options for specialist support is also beneficial - in writing if possible, as acutely traumatised people frequently experience impaired short term memory.”

Early intervention can assist in reducing anxiety associated with normal symptoms, such as people worrying that their reactions are not normal, or that they are not recovering fast enough.

It can also help to reduce the severity and duration of these normal reactions, and mild cognitive strategies can assist with reducing unhelpful thoughts, such as helplessness and guilt.

As well as good professional support, high quality social supports are critical.

“Recent research has shown that good quality social supports decrease the severity and duration of PTSD. even in the absence of usual therapies.

“Assessing a person's psychosocial supports during initial screening can help a clinician determine if referral to a specialist psychological support would be beneficial.”

While mental health professionals need to be prepared for the changing landscape of trauma and disaster response, it’s important for practitioners to be aware of their own risk of vicarious or secondary trauma from repeated exposure to victims of trauma.

“Especially in the wake of large scale incidents,” says Mr Prescott.

“If practitioners are seeing a large volume of highly traumatised people they are advised to proactively seek supervision as a ‘check-in’, to ensure they are maintaining their self-care.

Professionals looking to upskill in the area of trauma and disaster response should visit the Centre of Post-traumatic Health at http://phoenixaustralia.org/ , which offers resources geared toward professionals, friends and family, and people directly impacted by traumatic events.